| NPI | 1306942453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 224P00000X Prosthetist (Licence: NC CPO00968) |
| Additional Taxonomies | 222Z00000X Orthotist (Licence: NC CPO00968) |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2007-09-11 |